Provider Demographics
NPI:1417138413
Name:TRICOUNTY MEDICAL EQUIPEMENT & SUPPLY LLC
Entity Type:Organization
Organization Name:TRICOUNTY MEDICAL EQUIPEMENT & SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GVODAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:610-705-9292
Mailing Address - Street 1:34 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5427
Mailing Address - Country:US
Mailing Address - Phone:610-705-9292
Mailing Address - Fax:610-705-9777
Practice Address - Street 1:34 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5427
Practice Address - Country:US
Practice Address - Phone:610-705-9292
Practice Address - Fax:610-705-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102053991 0001Medicaid
PA30048227OtherKEYSTONE MERCY
PA0002789000OtherINDEPENDANCE BLUE CROSS
PA0002789000OtherINDEPENDANCE BLUE CROSS